Abstract:
Introduction. Recent studies demonstrated that increased neutrophil-to-lymphocyte ratio (NLR)
and platelet-to-lymphocyte ratio (PLR) are associated with a risk of development and
progression of arterial and deep venous thrombosis, representing surrogate markers of
endothelial injury, inflammation and prothrombotic state. However, until now the role of NLR
and PLR in case of superficial venous thrombosis has not been determined.
Aim of the study. To evaluate the diagnostic value of the NLR and PLR in patients with varicose
veins of lower limbs complicated by acute superficial venous thrombosis.
Materials and methods. Thirty patients with acute superficial venous thrombosis (SVT)
confirmed by duplex ultrasound were prospectively included in study group. Thirty sex/age
matched patients with varicose veins without thrombosis (VV) were used as controls. On the
admission the NLR and PLR were calculated from full blood count in all patients. The values of
D-dimer and C-reactive protein were determined in SVT group before treatment initiation.
Results. Median age of the patients was 60 (25%-75% IQR 55-66) years, 56% were female. In
the study group thrombosis involved only varicose tributaries in 16 (53,3%) cases and the main
saphenous trunk in the remaining. In SVT patients the median values of D-dimer and C-reactive
were 635,0 ng/ml (25%-75% IQR 280-1208) and 9,5 mg/L (25%-75% IQR 2-45,2). The median
values of PLR and NLR both were significantly higher in patients with SVT compared to VV
group: 147,2 (25%-75% IQR 119-195) vs 113,5 (25%-75% IQR 91-141) and 3 (25%-75% IQR
2,3-3,7) vs 1,7 (25%-75% IQR 1,5-2,3), respectively (p<0,01). NLR showed moderate positive
correlation with level of D-dimer in SVT group: r=0,4 (p<0,05). There were no correlations of
PLR and NLR with the level of C-reactive protein. A trend to higher values of PLR and NLR in
patients with main saphenous trunk involvement was observed (p>0,05). ROC-curve analysis
demonstrated acceptable role of PLR (area under curve = 0,73) and NLR (area under curve =
0,78) for diagnosis of SVT. Using cut-off value of NLR > 2, thrombosis was predicted with
sensibility of 87% and specificity of 70%.
Conclusions. NLR and PLR are not expensive and universally available laboratory tests that can
serve as an adjunct for the diagnosis of superficial vein thrombosis in patients with varicose
veins of lower limbs. Further studies are required to determine the utility of NLR and PLR for
prediction of proximal extension and recurrence of superficial venous thrombosis.
